A Prospective Study of Distal Metatarsal Chevron Osteotomies with K-Wire Fixations to Treat Hallux Valgus Deformities

Pin fixation is an effective method for fixation of bunion osteotomy with various procedures: a retrospective cohort study

BACKGROUND

Various fixation devices are available for bunion osteotomy. In this study, we evaluated the radiographic outcomes, postoperative complications, and recurrence rate in a series of hallux valgus deformities treated with various osteotomy procedures using a pin for the fixation of the osteotomy.

METHODS

Two-hundred forty-seven patients with hallux valgus deformity managed with a Simple, Effective, Rapid and Inexpensive (SERI) osteotomy, distal chevron osteotomy, or proximal crescentic osteotomy and K-wire fixation were included. The mean follow-up of the patients was 53.9 ± 8.9 months. Radiographic evaluations included the assessment of the Hallux valgus angle (HVA), intermetatarsal angle (IMA), and union. Clinical evaluations included the assessment of the range of motion, pain in the first metatarsophalangeal joint, and patient satisfaction.

RESULTS

In the last visit, the mean improvement of HVA was 23.9 ± 9.1º (P < 0.001). The mean IMA improvement was 6.1 ± 6º (P < 0.001). The mean metatarsophalangeal flexion and extension were 33 ± 10.7º and 34.6 ± 9.2º, respectively. Postoperative complications included pin tract infection in eight (3.2%) patients, deep infection in five (2%) patients, and early pin complication in four (1.6%) patients. Recurrence was observed in five (2%) patients. Twenty-three (9.3%) patients had slight pain in the last follow-up. The mean surgical time was smaller in the SERI osteotomy (P < 0.001). The mean hospitalization period was longer in the proximal osteotomy group (P = 0.039). The mean metatarsophalangeal flexion and extension were significantly smaller in the distal chevron osteotomy (P = 0.046 and P = 0.037, respectively). 90% of patients were satisfied or very satisfied with the surgical outcomes.

CONCLUSION

K-wire fixation is a safe and effective device for the fixation of bunion osteotomy, and this effectiveness is even higher with SERI and proximal crescentic osteotomy.

Stability of osteotomy in minimally invasive hallux valgus surgery with "8" shaped bandage during gait: a finite element analysis

Introduction

Hallux valgus, a common foot deformity, often necessitates surgical intervention. This study evaluates the biomechanical alterations in patients post-surgery, focusing on the efficacy of an "8" bandage fixation system to promote optimal recovery.

Methods

A three-dimensional (3D) model was constructed using CT data from a patient with hallux valgus. A quasi-static finite element analysis (FEA) was conducted in conjunction with gait analysis to evaluate the biomechanical changes at the osteotomy site under "8" shaped bandage fixation following hallux valgus surgery. The effects of the "8" shaped bandage on the stability of the osteotomy site and bone healing were investigated at three load points during the gait cycle.

Results

During the Loading Response (LR), Midstance (MSt), and Terminal stance TSt phases, the osteotomy end experienced maximum Von Mises stresses of 0.118, 1.349, and 1.485 MPa, respectively. Correspondingly, the maximum principal stresses, all of which were compressive along the Z-axis, were 0.11662 N, 1.39266 N, and 1.46762 N, respectively. Additionally, these phases showed a maximum relative total displacement of 0.848 mm and a maximum relative shear displacement of 0.872 mm.

Conclusion

During the stance phase, the osteotomy end of the first metatarsal is predominantly subjected to compressive stress, with the relative displacement within the safe range to promote healing. The application of an "8" bandage for external fixation after surgery can maintain the dynamic stability of osteotomy sites post-minimally invasive hallux valgus correction during the gait cycle, thereby promoting the healing of the osteotomy ends.

Giant Cell Tumour of Knee Popliteus Muscle Synovial Sheath

The giant cell tumour of the tendon sheath (GCTTS) is the second most common soft tissue benign tumour and rarely presents in the knee. We report a rare presentation of a GCTTS in the knee with corresponding magnetic resonance imaging (MRI), an arthroscopic picture, and histological presentation. It is a rare occurrence but should be considered as a differential in atraumatic knee pain presentation. This case report gives a classic picture of its presentation, diagnosis, and histopathology.

An Unusual Presentation of Osteochondroma in a Sexagenarian

Osteochondroma is the most commonly-found benign bone tumour. It is a benign, cartilaginous-capped bony projection. They are usually present on the bony surfaces of the long bones in adolescents and young adults. The risk of malignant transformation is <1% with solitary osteochondroma. We present a rare case of an osteochondroma in a patient with advanced age and an unusual location.

Improving Management of Paediatric Buckle Fracture in Orthopaedic Outpatients: A Completed Audit Loop

Introduction

Paediatric patient bone fractures are the source of a large number of orthopaedic outpatient visits, especially for fracture clinics. The National Institute for Health and Care Excellence (NICE) guideline NG38 provides guidance on assessing and managing non-complex fractures, such as buckle (i.e., torus) fractures in paediatric patients.

Objective

We retrospectively audited outpatient records of children younger than 12 years presenting with distal radius buckle fractures for May and June 2017. We compared our practice against the NICE guideline standards. We made certain changes in our practice and then repeated the exercise prospectively for two months from July 15 to September 15, 2017.

Material and Methods

We identified 31 patients who fit our inclusion criteria. After instituting changes based on the NICE guidelines, the number of children included in the prospective data collection was 33 patients.

Results

For the 31 children treated according to our older protocol, we had 59 outpatient visits, with an average of 1.90 visits for every child. After the NICE-driven changes were made to our management, 33 patients were treated in 39 visits with an average of 1.2 visits per child.

Conclusion

Introducing NICE guidelines allowed for considerable improvement in the management and treatment of paediatric patient bone fractures. It is important to fully implement the NICE guidelines not only in fracture clinics but also in other departments, such as accident and emergency departments.